Not for sissies, they say! Ageing is an inevitable process, but its effects can be more complex for those with a spinal-cord injury.
Life comes with only one guarantee – at some stage we will reach the end of our lives. For some, tragically, life ends far too soon; others have a long and sometimes difficult existence into old age.
As we grow older, our bodies change. In the individual with a spinal-cord injury (SCI), there are many changes that need to be accommodated as that person ages. Health problems that occur as a direct consequence of SCI are commonly termed secondary health conditions. Many SCIs occur between 18 and 35 years of age and therefore a long life as a paraplegic is expected. This brief summary highlights the secondary health conditions that need to be monitored.
- Skin problems. Often SCI patients spend many hours in a wheelchair. With a vigilant approach, pressure sores can be prevented. However, as one ages, skin becomes less elastic and thinner (sometimes made worse by some commonly prescribed medications) and extra care must be taken. Adequate hydration with a good aqueous cream is necessary, and the use of cushions and mattresses is recommended.
- Musculo-skeletal changes.
Muscle and fat. Muscle loss is prevalent with ageing. It is often replaced by fat, especially around the abdomen, resulting in increased weight and all the associated risks (cardiovascular disease, diabetes). The extra weight makes one more vulnerable to pressure sores.
Bones. Remember that all SCI individuals will suffer from osteoporosis and care must be taken to prevent fractures.
Joints. Many patients, especially those who are active in their wheelchairs, will suffer from increasing frequency of “upper limb syndromes”. These include painful shoulders (various forms of tendonitis or inflammation of the tendons in and around the shoulder) and tears of the structures supporting the shoulder (rotator cuff injuries). Also commonly seen is carpal tunnel syndrome, with pain and sensory changes in the hand and wrist.
Changes in the spine. As one ages, osteoarthritic changes occur. Changes in the spine with possible scoliosis and secondary increase in spasm will need to be monitored, and posture and support checked by an occupational therapist or physiotherapist.
- Nervous system. As we age, we lose neurons in the brain. This is not limited to those in a wheelchair! Poor memory and planning may mean that caregiver assistance is required.
- Endocrine. Age-related changes in various hormones is not a SCI-specific condition. Specialist follow-up is required if endocrine deficiencies are noted. There are important hormonal changes at menopause and hormone replacement therapy may be prescribed by a gynaecologist. In men testosterone and libido changes are common. People may become prone to maturity onset diabetes (Type 2) and thyroid dysfunction may also be common in older persons.
- Cardiovascular. There is an increased risk of cardiovascular disease in SCI individuals. The metabolism of fats in SCI is affected and therefore monitoring of cholesterol and blood pressure is important.
- Respiratory. Where the lesion is high in the spine, respiration is already compromised. As one ages, there is normally a slow decrease in lung capacity. This is exacerbated in those who smoke.
- Gastro-intestinal. Routine screening for colon cancer is imperative from age 50. In SCI individuals, transit times appear to increase with age and the use of more laxatives becomes necessary. With decreasing activity, kilojoule intake should be reduced – this will help avoid obesity.
- Genito-urinary. Annual screening for kidney and bladder stones is important. With age the kidney function may become reduced. Catheter-wearing patients are at higher risk for cancer of the bladder.
Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: email@example.com